Access and Availability to Care – Office Closures and Use of Telehealth during the COVID-19 response period
AmeriHealth Caritas Louisiana continues to monitor the latest information regarding COVID-19, and wants to help ensure that our members have access to care for their health care needs. We ask that, in addition to notifying patients, any network provider who will be closing their office for an extended period of time notify AmeriHealth Caritas Louisiana at 1-888-922-0007, and indicate whether virtual visits, telephonic consultation, and/or secure web-portal consultation will be available during this period.
Providers are strongly advised to limit in-person encounters only to those which cannot be done through telemedicine/telehealth technologies. These in-person encounters must be urgent and medically necessary. Please see LDH IB 20-5 COVID-19 Provider Update (PDF) (revised April 3, 2020) for additional information.
The Louisiana Managed Medicaid Association has developed the Assessment of Telehealth Availability survey to determine telehealth availability for the state’s Medicaid population. Providers can access the survey at https://www.surveymonkey.com/r/BK7GYY5.
If your office plans to close or limit on-site visits and provide virtual, telephonic, or web-based support:
- See updated guidance on AmeriHealth Caritas Louisiana’s website provided by the Louisiana Department of Health (LDH) at http://www.amerihealthcaritasla.com/provider/newsletters-and-updates/index.aspx.
- Access recent telehealth guidance from the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) here: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html.
Providers who are interested in providing telehealth services, but are not yet doing so, you can access the Association for Community Affiliated Plans (ACAP) preferred vendors list at https://www.communityplans.net/?s=telehealth&content_type=preferred-vendors.
In accordance with your provider agreement, if you are unable to provide services, you must refer members to providers participating in the AmeriHealth Caritas Louisiana provider network.
View our list of providers offering telehealth services (PDF)
Referral options may be limited at this time, however, please contact our Provider Services line at 1-888-922-0007 if you need assistance.
Providers can also direct your patients who are our members to contact AmeriHealth Caritas Louisiana’s Member Services at 1-888-756-0004. We have tools in place to connect members to alternate providers who can support their continued care. Members can receive additional support by calling our 24/7 Nurse Call Line at 1-888-632-0009.
For current updates on the status of COVID-19 in Louisiana, please see the Office of Public Health (OPH) COVID-19 website, located at http://ldh.la.gov/Coronavirus/. AmeriHealth Caritas Louisiana will be providing updates as we receive them.
Telehealth Billing Reminders and Updates
AmeriHealth Caritas Louisiana covers telehealth visits for our members in accordance with State and Federal policy. Similar to Medicare, many states are adopting expanded or interim policies related to the originating site, payment for telephonic visits, and expanded licensure.
Current State guidance on coding:
- Billing Instructions (non-FQHC/RHC): Providers must indicate place of service 02 and must append modifier -95. Services delivered via an audio/video system and via an audio-only system should be coded this same way.
- Billing Instructions for FQHCs/RHCs: Providers must indicate place of service 02 and must append modifier -95 on the header and on all detailed service lines. Services delivered via an audio/video system and via and audio-only system should be coded this same way. Reimbursement for these services in an FQHC/RHC will be at the all-inclusive prospective payment rate on file for the date of service.
Relevant CPT codes covered in the overall telemedicine/telehealth policy are listed below. In addition, other services are eligible to be delivered via telemedicine/telehealth (e.g. PT/OT/SLT) and these are detailed Informational Bulletin 20-5.
| Category | Service | CPT Code(s) |
|---|---|---|
| Behavioral Health | See Medicaid Health Plan Advisories posted at http://ldh.la.gov/index.cfm/page/1198 | |
| Dialysis | End-stage Renal Disease Services | 90951, 09052, 90954, 90955, 90957, 90958, 90960, 90961 |
| Cardiovascular | Cardiovascular Monitoring Services | 93228, 93268, 93272 |
| Psychological, Neuropsychological Testing | Neurobehavioral Status Examination | 96116 |
| Evaluation and Management, Office or Other Outpatient Services | New Patient | 99201, 99202, 99203, 99204, 99205 |
| Established Patient | 99212, 99213, 99214, 99215 | |
| Hospital Inpatient Services | Subsequent Hospital Care | 99231, 99232, 99233 |
| Nursing Facility Services | Subsequent Nursing Facility Care | 99307, 99308, 99309, 99310 |
For additional telehealth coding guidance and policy information, please refer to the latest updates from the Louisiana Department of Health on our website at: http://www.amerihealthcaritasla.com/provider/newsletters-and-updates/index.aspx.
Providers should also reference Appendix P of the CPT Manual and the Louisiana Medicaid Fee Schedule toassure you are eligible to bill telehealth codes.
Louisiana Department of Health issues revised order for medical and surgical procedures
On April 20, 2020, the Louisiana Department of Health issued a revised order for medical and surgical procedures. This guidance is necessary during a public health emergency to preserve personal protective equipment, to properly utilize hospital staffing and to ensure adequate
hospital bed capacity. “Health care facilities play a critical role in responding to COVID-19 and helping people be their healthiest,” Gov. John Bel Edwards said. “We are quite some time away from returning to normal but this is a step in the right direction.”
The revised guidance, which goes into effect April 27, states medical and surgical procedures shall only be performed under the following conditions:
- in order to treat an emergency medical condition;
- to avoid further harms from an underlying condition or disease;
- and for time sensitive conditions.
Additionally, the order states dental visits, procedures and surgeries shall only be performed under the following conditions:
- in order to treat an emergency medical condition;
- to avoid further harms from an underlying condition or disease;
- and for time sensitive dental conditions.
Before facilities perform any procedure, each much have a plan in place to monitor for COVID-19 symptoms or test if possible; to ensure adequate physical distance between patients; must have a five-day minimum supply of PPE available; and must follow additional guidance outlined in the order.
The previous order allowed surgeries only for emergency medical conditions.
This order does not mean that all containment measures can be lifted across all facilities and specialties.
Healthcare services other than medical and surgical procedures should continue to happen via telehealth when medically appropriate.